UCL申请

PERSONAL DETAILS

(please complete in black ink)

1.Surname/Family Name (Block Capitals)

2.First Names (Block Capitals)

3.Title (Mr/Mrs etc.)

Day

Month Year

Male Female 6. Nationality 7. Country of Ordinary Residence

4.Date of Birth

5. Sex (√ )

8.Home address

9. Correspondence Address (if different)

Postcode

Postcode Tel.Fax

Tel.Fax

E-mail

E-mail

Dates when Address is Valid

FOR OFFICE USE. TO BE COMPLETED BY THE GRADUATE ADVISER/DEPARTMENTAL ADMISSIONS TUTOR ACCEPT

REJECT

WITHDRAWN

Signature

Date

If “REJECT”, CAO to send a standard letter?YES NO If “ACCEPT”, please complete appropriate boxes below:

1.Qual. (MA, Diploma etc.)

2. Programme Title/Research Field of Study

3. Method of Study (√ )

FT

PT

Modular PT

4. Start Date

5. Research Acad/Cal Yrs Months (if not Sept.)

Duration

6. First Research Supervisor

7. Second or Off-Campus Research Supervisor

8. Minimum Qualifications Required.

9. Other details/condititions for offer letter (eg. studentship or scholarship allocated/nominated for. If qualifying examination is to be set provide details here).

10. In section 15, overleaf, please tick which qualifications should be verified by the Registrar’s Division.

WHEN COMPLETED, PLEASE RETURN TO THE COLLEGE ADMISSIONS OFFICE, REGISTRAR’S DIVISION.

PROGRAMME OF STUDY FOR WHICH YOU WISH TO APPLY 10.UCLDepartment/Institute

11.Qualification Sought (MPhil/PhD, MSc etc.)12.Research Subject Area/Taught Programme Title 13.Method of Study (√ )

Full-time

Part-time (where available)

14. Proposed Starting Date

Month

Year

Taught programmes usually start in September or early October. Research students may begin in September, January,April or July. If there is an alternative programme for which you also wish to be considered, send a photocopy of your application and all supporting papers (except those in sealed envelopes) substituting the alternative details in this section.

EDUCATION

1 5.Detail your education since age 17. Start with the most recent. Include details of qualifications to be awarded. Where appropriate, professional qualifications should be listed .

Name of College/University/Awarding Body

Start End Qualification

Class of Degree Date of Main Subject(s) Studied

State Country if outside the UK

Date

Date

or Grade/Mark

Award

ENGLISH LANGUAGE

16.Is English your first language? (√ )

YES

NO

If “NO” detail any work experience or education that you have undertaken in English and/or the date and grade(s) achieved in the most recent English language test that you have taken. A copy of the test certificate should be enclosed with this application or forwarded later.

EMPLOYMENT

17.List your employment to date. You may include a copy of your curriculum vitae if this is more convenient. Medical or dental graduates should include full details of all periods of clinical training and clinical attachments.

Name and Address of Employer State Country if outside the UK

Dates

Position Held and Main Duties

FOR COLLEGE ADMISSIONS OFFICE USE Advice for graduate adviser/departmental admissions tutor Academically qualified: ( √ )YES NO AASC/Fac Board approval needed

English language satisfactory: ( √ )YES

NO

Qualifications required/comments: